Journal of neurosurgery
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Journal of neurosurgery · Jan 2022
Use of predictive spatial modeling to reveal that primary cancers have distinct central nervous system topography patterns of brain metastasis.
Brain metastasis is the most common intracranial neoplasm. Although anatomical spatial distributions of brain metastasis may vary according to primary cancer subtype, these patterns are not understood and may have major implications for treatment. ⋯ These data support the hypothesis that there is a nonuniform spatial distribution of brain metastasis to preferential brain regions that varies according to cancer subtype in patients treated with Gamma Knife radiosurgery. These topographic patterns may be indicative of the abilities of various cancers to adapt to regional neural microenvironments, facilitate colonization, and establish metastasis. Although the brain microenvironment likely modulates selective seeding of metastasis, it remains unknown how the anatomical spatial distribution of brain metastasis varies according to primary cancer subtype and contributes to diagnosis. For the first time, the authors have presented two predictive models to show that brain metastasis, depending on its origin, in fact demonstrates distinct geographic spread within the central nervous system. These findings could be used as a predictive diagnostic tool and could also potentially result in future translational and therapeutic work to disrupt growth of brain metastasis on the basis of anatomical region.
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Journal of neurosurgery · Jan 2022
Lesion location and outcome following cingulotomy for obsessive-compulsive disorder.
Obsessive-compulsive disorder (OCD) is among the most debilitating and medically refractory psychiatric disorders. While cingulotomy is an anatomically targeted neurosurgical treatment that has shown significant promise in treating OCD-related symptoms, the precise underlying neuroanatomical basis for its beneficial effects has remained poorly understood. Therefore, the authors sought to determine whether lesion location is related to responder status following cingulotomy. ⋯ Lesions in patients responsive to cingulotomy tended to be located more superiorly and posteriorly and share greater coverage of a posterior subregion of BA32 than lesions in patients not responsive to this treatment.
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Journal of neurosurgery · Jan 2022
Fluorescence real-time kinetics of protoporphyrin IX after 5-ALA administration in low-grade glioma.
5-Aminolevulinic acid (5-ALA) induces fluorescence in high-grade glioma (HGG), which is used for resection. However, the value of 5-ALA-induced fluorescence in low-grade glioma (LGG) is unclear. Time dependency and time kinetics have not yet been investigated. The purpose of this study was to investigate real-time kinetics of protoporphyrin IX (PpIX) in LGG based on hyperspectral fluorescence-based measurements and identify factors that predict fluorescence. ⋯ This study reports a fluorescence-based assessment of CPpIX in human LGG tissues related to 18F-FET PET uptake and Ki-67/MIB-1. As in HGGs, fluorescence in LGGs peaked between 7 and 8 hours after 5-ALA application, which has consequences for the timing of administration.
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Journal of neurosurgery · Jan 2022
PHASES score and treatment scoring with cigarette smoking in the long-term prediction of rupturing of unruptured intracranial aneurysms.
Treatment indications in unruptured intracranial aneurysms (UIAs) are challenging because of the lack of prospective natural history studies without treatment selection and the decreasing incidence of aneurysm rupture. The purpose of this study was to test whether the population, hypertension, age, size of aneurysm, earlier aneurysm rupture, site of aneurysm (PHASES) score obtained from an individual-based meta-analysis could predict the long-term rupture risk of UIAs. ⋯ The PHASES and the new scores predicted the long-term aneurysm rupture risk moderately well, with the latter, which also included smoking, being slightly better and easier in clinical practice. The findings suggest that treatment decisions about UIAs in patients of working age can be done with an improved cost-effectiveness.
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Journal of neurosurgery · Jan 2022
Glioma-related epilepsy in patients with diffuse high-grade glioma after the 2016 WHO update: seizure characteristics, risk factors, and clinical outcomes.
The aim of this study was to investigate the epidemiological characteristics, associated risk factors, and prognostic value of glioma-related epilepsy in patients with diffuse high-grade gliomas (DHGGs) that were diagnosed after the 2016 updated WHO classification was released. ⋯ The updated WHO classification seems conducive to reveal the distribution of glioma-related epilepsy in DHGG patients. For DHGG patients with high-risk predictors of poor seizure control, timely antiepileptic interventions could be beneficial. Moreover, glioma-related epilepsy (especially postoperative glioma-related epilepsy) is associated with favorable overall survival.